Many doctors believe that the best treatment for sleep apnea is a CPAP, or continuing positive air pressure machine or BiPAP, a bi-level positive air pressure machine. While CPAP or BiPAP is the gold standard and has helped countless people enjoy more restful, safe sleep, many are intolerant of the device. Because non-treatment of sleep apnea results in potential health risks and loud snoring, treatment is important. For CPAP intolerant patients, Dr. Gershberg provides an alternative – an oral appliance that eliminates obstructive sleep apnea in most people.

About CPAP

CPAP machines are made of three primary components: the main unit that creates air pressure, an air hose, and facemask. The main unit compresses air, then channels it through the air hose and facemask with steady pressure. This system of continual air delivery keeps soft oral and throat tissues from blocking airflow as a patient sleeps, thus eliminating apneic episodes. Thirty to fifty percent of CPAP patients are non-compliant, due to a variety of reasons. Some of the most common complaints include:

My mask leaks air

My mask does not fit well

The device has uncomfortable straps and headgear

I cannot sleep due to sounds from device

CPAP disturbs my bedmate’s rest

It restricts my movements

It is simply not effective

Pressure on my upper lip has caused dental problems

I suffer with claustrophobia

During the night, I am unaware of removing my CPAP mask

According to online articles and forums, there are many additional problems that CPAP patients may experience. These include, but are not limited to:

Esophagus problems, such as acid reflux, nausea, and vomiting

Gas and bloating from air in the stomach (aerophagia)

Sinus or nasal issues, including mucous and congestion as a result of silicone components and having a dry nose

Dry mouth, or xerostomia, which can increase the risk for tooth decay and gum disease

Dry eyes or puffy eyes, usually due to a mask not fitting well or exhalation ports directing air at the eyes

Lung or chest pain, often due to the increased workload of the lungs, because exhaling requires combatting a constant influx of air

Psychological dependence on CPAP, meaning unable to fall asleep without the device

Condensation in the CPAP air hose, called rain out, which involves air in the tube going up the nose

Continued problems with snoring, which may happen when the device is not properly calibrated for the patient

Reduced libido, due to the psychological impact of a CPAP not being attractive

Medical professionals often recommend giving CPAP at least one year before deciding to seek alternative treatment. Some of the problems can be addressed and solved. However, because of a high instance of non-compliance, CPAP machines are not always the best treatment option for patients with obstructive sleep apnea, or OSA. Sleep medicine doctors, general physicians, and dentists may recommend an alternative, such as surgery or positional therapy. Lifestyle changes, such as weight loss or abstaining from alcohol and tobacco may effectively eliminate OSA in some patients. Another option is a comfortable, compact, and convenient OSA appliance available at Dr. Gershberg’s Main Line dental office, in Bryn Mawr, PA.

About an OSA Appliance

Similar to an oral splint or mouth guard, an OSA appliance is also known as a snore guard. More than one hundred FDA-approved oral sleep apnea appliances are available on the market today. Each device is made from comfortable plastic, and should be worn during sleep. A person’s lower jaw tends to move slightly backward, toward the neck, when muscles relax during sleep. The OSA appliance holds the lower jaw forward, just slightly, which results in a clear air passage. The patient does not snore or suffer apneic episodes when wearing an FDA-approved appliance. This simple device has improved the lives of many OSA people, particularly those who cannot tolerate CPAP or find it ineffective. Note that over-the-counter boil-and-bite appliances are not FDA approved and some can ultimately lead to dental or jaw problems.

Is Your OSA Therapy Working?

Whether you opt for CPAP, BiPAP, or an oral appliance to treat sleep apnea, the results of your therapy will be evident by whether or not your symptoms subside. For instance, snoring, waking with snorts or coughs through the night, waking with a sore throat or dry mouth, morning headaches, earaches, irritability, forgetfulness, depression, daytime drowsiness or fatigue, and impotence related to OSA should go away with effective treatment. You will need to attend follow-up appointments with your physician or dentist to review your symptoms and determine if treatment is working.

Comparison of Treatments

Size: An oral appliance for sleep apnea is small, compact, and easy to transport when travelling. It’s also convenient to store in a nightstand or medicine cabinet. In contrast, a CPAP requires a carrying case that’s approximately the size of a small briefcase.

Sound: Various CPAP machines have different noises, and some people notice a whistling noise from their mask. An OSA appliance does not make any sound.

Comfort: As mentioned above, CPAP intolerant patients have many complaints about discomfort, either from feeling confined, claustrophobic, or wearing the mask. Those who opt for nasal pillow masks may have soreness on their nostrils, upon waking. Some patients report sores and bruises from ill-fitting masks. In contrast, most patients who wear an OSA appliance do not report discomfort, and in addition, various sleep appliances are available for a wide range of fitting options.

Convenience: Because of its size, CPAP takes up more space and is more difficult to transport than an oral appliance for OSA. And due to having three main components, CPAP machines have a greater opportunity for malfunctions and problems. As long as you have access to electricity, a properly calibrated CPAP with a good-fitting mask can be very effective, as can a comfortable OSA appliance.

Care and Maintenance: CPAP requires refilling with distilled water and weekly soaking, for the humidifier feature to remain clean and function properly. The filter and air tube must be cleaned weekly, and replaced as per the model’s instructions (usually monthly or twice a year). Daily cleaning of the CPAP mask is imperative to avoid bacteria build up. All components must be air dried before reassembly. The mask cushions usually need to be replaced one or two times per month, and a new mask is require two to four times per hear. An oral appliance for OSA should be cleaned with cool water and a toothbrush, using toothpaste or a special cleanser, after each use.

Cost: If you’re relying on insurance to help pay for OSA treatment, you may be required to first try CPAP. If the patient is CPAP intolerant, insurance may cover a portion of an OSA appliance. Generally, CPAP comes with a smaller cost, but for CPAP intolerant patients, an ineffective treatment is of no use. For those who do not like CPAP, an OSA appliance is the best, most cost effective option.

Consider Your Partner

CPAP wearers often get negative feedback from roommates or partners who share their sleeping space. Though when it works properly, CPAP can eliminate a patient’s snoring, which is a big relief to those within earshot. However, the machine itself, and the mask’s exhalation ports, make noise. If the sounds from a CPAP machine interfere with a bedmate’s or roommate’s sleep, that person can suffer from poor sleep or sleep deprivation.